Peaks, troughs and stark warnings

If you had any doubt about the priorities facing the Welsh government during the next Assembly term and beyond, then the Director of the Royal College of Nursing in Wales has spelt them out pretty starkly.

You will put "creating economic growth" right at the top and few would disagree. But Tina Donnelly is clear that there is another urgent priority in the health minister's in-tray, a problem that unless it's tackled, will engulf Lesley Griffiths.

Clinicians offering acute services are used to busy winters. More people get ill, flu epidemics flare up, Accident and Emergency departments are full to bursting. The problem this year is that the added pressure didn't ease off as the sun came out and the jumpers came off. The demand has been "unprecedented" throughout the summer say the RCN. Forget peaks and troughs - think peaks, constant peaks, unsustainable peaks that drain both the staff and the budget.

Why?

Let's be clear: Tina Donnelly doesn't put this surge in demand down to daft 999 calls. This isn't about hamster bites and drunken calls for an ambulance because it's cheaper than a taxi. This is about the closure of minor injury units, she argues, when there aren't enough clinicians to provide cover. This is about not enough of the much-vaunted alternative care in the community, about people not trusting that care, about people turning up in A+E and acute care hospitals because they know they'll get quality care. They know the staff on the front line - and the Local Health Board - will treat them and won't turn them away.

Tina Donnelly is blunt: "The difficulty is you cannot help being ill in Wales so the demand is there ... Let's be clear, when the Assembly returns we have to make it really a priority in Wales to say we've got unprecendented utilisation of acute care services, we have inadequate provision in the community. That has to be fixed otherwise I don't know how health boards are going to manage, I really don't".

Those health boards are already overspending. They've been told there's no more money to bail them out. They've been told by the Health Minister that this time, she means it.

She may well mean it but Tina Donnelly means it too when she says the demand for acute care is sky high, that it cannot be sustained on current budgets and that it "has to be fixed."